P0752 - Herbal Medicine for Active Ulcerative Colitis: Systematic Review and Meta-Analysis

Preetha Iyengar, MD¹, Gala Godoy Brewer, MD², Isha Maniyar, BS³, Alyssa M. Parian, MD⁴, White Jacob, MS⁵, Maas Laura, MD⁶, Berkeley Limketkai, MD, PhD^7
1University of California Los Angeles, Santa Monica, CA; ²University of Miami/Jackson Memorial Hospital, Miami, FL; ³University of California Los Angeles, Los Angeles, CA; ⁴Johns Hopkins, Baltimore, MD; ⁵Johns Hopkins University Welch Medical Library, Baltimore, MD; ⁶Johns Hopkins University, Baltimore, MD; ⁷UCLA, Los Angeles, CA

Introduction: Herbal medicines are the most used integrative medicine approach by patients with inflammatory bowel disease. However, there is limited high-quality evidence available to guide patients and providers in their use. Our study aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the efficacy and safety of herbal medicines in patients with active ulcerative colitis (UC).

Methods: Literature search was performed using embase.com, pubmed.gov, Medline via ovid.com, and Medline, Biosis, and Web of Science Core Collection via webofscience.com based on Emtree terms “ulcerative colitis”, “medicinal plant”, “plant extract”, “plant medicinal product”, and “randomized controlled trial” from inception to 2022. RCTs investigating treatment of active UC with single herbal medicines were included, while those with multiple herbal constituents, animals, or UC in remission were excluded. Outcomes included clinical response, clinical remission, endoscopic response, endoscopic remission, and adverse events (AEs). Risk ratios and 95% confidence intervals were calculated for significance.

Results: We identified 28 RCTs for 17 herbs (Table). In pooled analyses of amenable RCTs, when compared with placebo, clinical response rates were significantly higher for Indigo naturalis (IN) (RR 3.70, 95% CI 1.97-6.95), but not for Curcuma longa (CL) (RR 1.60, 95% CI 0.99-2.58) or Andrographis paniculata (AP) (RR 0.95, 95% CI 0.71-1.26) (Figure). There was a significantly higher rate of clinical remission for CL (RR 2.58, 95% CI 1.18-5.63), but not for AP (RR 1.31, 95% CI 0.86-2.01). Higher rates of endoscopic response (RR 1.56, 95% CI 1.08-2.26) and remission (RR 19.37, 95% CI 2.71-138.42) were significant for CL. One RCT for AP reported a higher rate of serious AEs and one RCT for IN reported a higher rate of mild liver dysfunction in the treatment group compared to placebo, but incidence of AEs was similar between groups in other RCTs. Overall quality of evidence based on GRADE was very low.

Discussion: Our findings suggest a potential role for augmentation of standard care in the treatment of active UC with CL. Although IN had favorable results, further safety data is needed based on external reports. Other promising herbal medicines, such as Boswellia serrata and Punica granatum, warrant further investigation. Further research with larger scale RCTs, manufacturing standardization, and education for patients and providers are needed.




Disclosures:


Preetha Iyengar, MD¹, Gala Godoy Brewer, MD², Isha Maniyar, BS³, Alyssa M. Parian, MD⁴, White Jacob, MS⁵, Maas Laura, MD⁶, Berkeley Limketkai, MD, PhD⁷. P0752 - Herbal Medicine for Active Ulcerative Colitis: Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.